Case Report: Severe Frostbite in Extreme Altitude Climbers-The Kathmandu Iloprost Experience.
- Pandey P CIWEC Hospital and Travel Medicine Center, Kathmandu, Nepal (Drs P Pandey, Pradhan, and K Pandey). Electronic address: prativapandey@ciwec-clinic.com.
- Vadlamudi R Packard Health, Ann Arbor, MI (Dr Vadlamudi).
- Pradhan R CIWEC Hospital and Travel Medicine Center, Kathmandu, Nepal (Drs P Pandey, Pradhan, and K Pandey).
- Pandey KR CIWEC Hospital and Travel Medicine Center, Kathmandu, Nepal (Drs P Pandey, Pradhan, and K Pandey).
- Kumar A Department of Medicine and Physiology, University of Fribourg, Fribourg, Switzerland (Dr Kumar); Department of Primary Care & Public Health Sciences, King's College London, London, UK (Dr Kumar).
- Hackett P Altitude Research Center, University of Colorado School of Medicine, Aurora, CO; Institute for Altitude Medicine, Telluride, CO (Dr Hackett).
- 2018-06-12
Published in:
- Wilderness & environmental medicine. - 2018
Everest
amputation
climbing
cold injury
mountaineer
Adult
Altitude
Amputation
Frostbite
Humans
Iloprost
Male
Middle Aged
Mountaineering
Nepal
Platelet Aggregation Inhibitors
Time Factors
Toes
Treatment Outcome
Young Adult
English
Severe frostbite occurs frequently at extreme altitude in the Himalayas, often resulting in amputations. Recent advances in treatment of frostbite injuries with either intravenous or intra-arterial tissue plasminogen activator, or with iloprost, have improved outcomes in frostbite injuries, but only if the patient has access to these within 24 to 48 h postinjury, and ideally even sooner. Frostbitten Himalayan climbers are seldom able to reach medical care in this time frame. We wished to see if delayed iloprost use (up to 72 h) would help reduce tissue loss in grade 3 to 4 frostbite. In a series of 5 consecutive climbers with severe frostbite in whom we used iloprost, 4 of whom received treatment between 48 and 72 h from injury, 2 had excellent results with minimal tissue loss, and 2 had good results with tissue loss less than expected. The 1 patient with a poor outcome likely experienced a freeze-thaw-refreeze injury. This small series suggests that iloprost can be beneficial for severe frostbite, even after the standard 48-h window and perhaps for up to 72 h.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.wem.2018.03.003
- PMID 29887348
- Persistent URL
- https://sonar.ch/global/documents/139066
Statistics
Document views: 59
File downloads:
- Full-text: 0